Role Overview: Alameda Health System is hiring! Under the direction of the Vice President of Care Management, the Director of Inpatient System Care Management manages the day-to-day operations of the inpatient Care Management across all AHS facilities, including post-acute care facility for ensuring efficient patient flow, beginning when a patient is admitted to the facility and ending with a safe and clinically appropriate discharge.
DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.
- Accountable for Patient Care Coordination activities including system-wide Case Management, Care Coordination and Discharge Planning.
- Aligns Case Management with AHS strategic and operational objectives.
- Optimizes efficient care management/care coordination roles and processes, initiates process improvements.
- Develops, monitors and evaluates inpatient Care Management Metrics; manages the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to avoidable/variance days, readmissions, one-day stays, DRGs, LOS.
- Develops, maintains and implements Case Management policies, practices and procedures in accordance with CMS, CA DCHS, the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies; integrates managed care contract criteria into overall Case Management functions.
- Works closely with the VP of Care Management and Physician Advisors on any audits and secondary reviews; may include but not limited to direct and coordinate data gathering, chart audits and participants in internal and external meetings.
- Oversees educational needs and plan for inpatient Care Management division.
- Recruits, trains and coaches the management staff to assist them with performing optimally and provides appropriate discipline/structure; consults and assists Care Management managers with problem-solving with staffing, personnel issues, budget issues and resource management; reviews and evaluates management staff performance, initiates personnel transactions and meets hospital standards for performance evaluations.
- Supports the VP of CM with completion of financial analyses including cost of care to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization, clinical documentation/queries, quality care and patient safety; oversees the inpatient recovery process; works closely with Revenue Cycle and AHS Physician Advisors; regularly communicates with payors and/or their contracted vendors.
- Responsible for the coordination and support of the AHS Utilization Review Committee.
- Responsible for overseeing patient, physician and staff satisfaction based on quality outcomes and patient experience reporting; in conjunction with the Quality Leadership, identifies utilization issues affecting the quality of patient care.
- Provides AHS physicians, nursing and staff education including InterQual® criteria methodology, resource management, medical necessity guidelines, payer sources, clinical outcome metrics, length of stay initiatives, readmission strategies, reimbursement rules and medical record documentation requirements.
- Serves as Content Expert/Liaison to community agencies, AHS and Non AHS primary care provider network and all AHS stakeholders across all AHS facilities (i.e. Nursing and Hospital Administrators) for provision of care and services across the continuum of care.
- In conjunction with department managers and/or supervisors coordinates, develops, and implements action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuum.
- Assumes accountability for improving utilization metrics associated with department/unit and meeting organizational/departmental targets.
- Evaluates, plans, and executes changes in department procedures, equipment and supplies.
- Performs all other duties as assigned.
MINIMUM QUALIFICATIONS: - Required Education: Master's degree in Nursing or Master's degree in Social Work or related field.
- Required Experience: Seven to ten years of case management or quality experience in addition to progressive management experience in a large healthcare organization is required.
- Preferred Experience: N/A
Required Licenses/Certifications: Active licensure as a Registered Nurse in the State of California or valid license as a Clinical Social Worker issued by the State of California Board of Behavior Science Examiners; active BLS - Basic Life Support Certification issued by the American Heart Association; CPI -Crisis Prevention Intervention Training; Other advanced life support certifications may be required per unit/department specialty according to patient care policies.
Preferred Licenses/Certifications: Certification in Case Management, CCMC or ACM.
